Wednesday, May 13, 2015

Count me uneasy......

.....at the FDA's proposed new rule allowing homosexual and bisexual men to donate blood, given that it appears that 20% of urban homosexual men have the virus. The proposed rule says that if a man who has had sex with another man has abstained from that for at least a year, he is eligible, since blood tests are 99.97% likely to detect any infection he has. However, an infection in the past three months may be undetected up to 5% of the time if this source is correct.

To place things in perspective, the current rate of HIV infection via blood is 1 per 1.5 million transfusions--about 10 per year if this is correct. Given the relative rates of detection, this means that there are somewhere between 200 and 35000 people per year who either do not know they are at risk (infected partner who lies to them), or otherwise willfully lie about their risk category--IV drug use, prostitution, or having sex with a homosexual or bisexual man. The CDC data indicate that most infected people know their risk status, so I am guessing "lying" is the cause for almost all of these tragedies.

So what the FDA is saying, in effect, is that there is a significant population of homosexual and bisexual men who have been abstinent for over a year, and moreover that eliminating the overall ban would not encourage the non-abstinent portion of the population from lying to give blood. Let's approach the first first; if heterosexual behavior is indicative, something around 10-20% of adults are abstinent non-virgins. That would be 3-600,000 men, of whom maybe 5% might be expected to donate. They're probably also less likely to be infected with HIV for obvious reasons--say < 5% instead of 20% --so we would expect less than one additional infection per year with this policy. If we're losing people that could be saved with a timely blood transfusion, this might be an acceptable tradeoff.

If, of course, a portion of the other 80-90% of adult homosexuals don't make a "little white lie" to do the same. I do not know what portion would, but count me very uneasy about this. The current situation requires close to a dozen lies during the blood donation process for someone in a risk group (MSM, IV drug use, prostitution, etc..) to be allowed to donate. However if an updated donation process requires only one, and those in that group decide they can make one lie where they couldn't make 12, things could get really, really ugly.

Bingo. It appears to be politically driven and only the most egregious cases--those where someone has been "active" in the past few months--are nasty enough for the FDA to be concerned. But hey, each type 2 screening error only affects three recipients.....